[EurSafety Health-Net: MRSA Eradication in Nursing Homes and Home Care - A Practice Report]. / EurSafety Health-Net: MRSA-Sanierung in der Pflege (MSP) - ein Praxisbericht.

In 2009 the project EurSafety Health-Net, funded by Interreg IVa, was initiated in order to create a cross-border quality alliance to enhance patient safety in the field of infectious diseases. Within this framework, several studies and projects addressing key topics of infection control were carried out. We describe the two-year project "MRSA decolonisation in care settings (MSP)", which aimed at evaluating a simple and economic way of decolonisation of non-hospitalised MRSA carriers in 2 districts in Lower Saxony. In the course of the project 181 decolonisations of MRSA carriers were performed by nursing homes and nursing services for outpatients in cooperation with the local public health authorities of the districts Ammerland and Grafschaft Bentheim. Of 181 cases 134 were eligible for statistical analysis. The project provided protocols for 2 different starting situations: 1) Continuing and completing a decolonisation treatment subsequent to a hospital stay by nursing services for outpatients or in a nursing home. 2) Starting a decolonisation treatment in a nursing home or by nursing services for outpatients. The carriers were provided with the required materials either by the hospitals (situation 1) or by the local public health authorities (situation 2) free of charge. The decolonisation treatment and the testing were offered only to carriers free of properties deemed as decolonisation obstacles and was applied without involvement of the general practitioner. Short- and long-term success of the 5 day decolonisation treatment was tested afterwards by two swabs (14 days and 6 months after the end of the treatment). The results of the 6-month control swabs showed that 45% of the carriers were successfully decolonised in the long term. All parties involved regarded the procedure of the MSP project as effective with respect to the target. Thus, even after the project was finished, both districts continued applying the MSP protocol.

Transmission of shiga toxin-producing Escherichia coli O104:H4 at a family party possibly due to contamination by a food handler, Germany 2011.

We investigated a cluster of shiga toxin-producing Escherichia coli (STEC) O104:H4 infections after a family party during a large STEC O104:H4 outbreak in Germany. To identify the vehicle we conducted a retrospective cohort study. Stool samples of party guests, and food and environmental samples from the catering company were tested for STEC. We defined cases as party guests with gastrointestinal symptoms and laboratory-confirmed STEC infection. We found 23 cases among 71 guests. By multivariable analysis consumption of salmon [odds ratio (OR) 15, 95% confidence interval (CI) 2.3-97], herb cream (OR 6.5, 95% CI 1.3-33) and bean salad (OR 6.1, 95% CI 1.4-26) were associated with STEC infection. STEC O104:H4 was detected in samples of bell pepper and salmon. The food handler developed STEC infection. Our results point towards transmission via several food items contaminated by a food handler. We recommend regular education of food handlers emphasizing their role in transmitting infectious diseases.

MRSA-ST398 in livestock farmers and neighbouring residents in a rural area in Germany.

Prevalence of and risk factors associated with MRSA-ST398 carriage in 1872 (response 70%) farmers and neighbouring residents in a pig- and poultry-dense area in Germany were investigated using a cross-sectional study and self-sampling nasal swabs. In the population, 1% without occupational livestock contact and 24% with occupational livestock contact tested positive for MRSA-ST398. The group without occupational livestock contact was 3·8 times [95% confidence interval (CI) 1·5-9·3] more likely to be colonized if a household member had livestock contact and 3·2 times (95% CI 1·4-7·4) more likely if they regularly made private farm visits (e.g. to buy eggs or milk). In the group with occupational livestock contact, pig contact had an odds ratio of 7·1 (95% CI 2·9-17·2) for MRSA-ST398 acquisition. This is the first study to associate private farm visits with acquisition of MRSA; more research to explore the exact transmission routes is necessary.

[Comparison of the tuberculin skin test with the interferon-gamma test in the framework of a surroundings investigation in a prison]. / Vergleich von Tuberkulin-Hauttests und Interferon-Gamma-Tests im Rahmen einer Umgebungsuntersuchung in einer JVA.

After the occurrence of a multidrug-resistant tuberculosis in a prison of Lower Saxony (Germany), 223 contact persons (178 inmates, 45 staff members) were identified. To detect latent tuberculosis infections, all contact persons were tested with the tuberculin skin test (TST) and the interferon-gamma release assay (IGRA). An additional standardised questionnaire on anamnestic information and risk factors was completed by the participants. The statistical analysis included 149 male inmates with a mean age of 39 years. 61.1% of the inmates were born in Germany, 14.8% were born in the USSR or, respectively, its follow-up states. With the TST 29.5% of the inmates were tested positive, whereas with the IGRA the positive rate was 18.1%. For 7 inmates there was a positive IGRA despite a negative TST. The positive predictive value of TST with respect to IGRA was 45.5%, agreement was 79.2% (kappa=0.44). The agreement found in this study is comparable to studies within populations with lower incidence. Numerous investigations outside Europe indicate a high risk of tuberculosis infection among inmates.

Immunogene therapy for murine melanoma using recombinant adenoviral vectors expressing melanoma-associated antigens.

Adenoviral vectors expressing tumor-associated antigens can be used to evoke a specific immune response and inhibit tumor growth. In this study, we tested the efficacy of adenoviral vectors encoding human gp100 (Ad2/hugp100), murine gp100 (Ad2/mugp100), or murine TRP-2 (Ad2/muTRP-2) for their ability to elicit a specific cellular immune response and inhibit the growth of B16 melanoma tumor cells in the mouse. C57BL/6 mice were immunized with Ad2/hugp100, Ad2/mugp100, or Ad2/muTRP-2 either 2 weeks prior to B16-F10 tumor challenge (prophylactic treatment) or 3 days after tumor challenge (active treatment). Ad2/hugp100 and Ad2/muTRP-2 administered to two or more intradermal (i.d.) sites inhibited subsequent subcutaneous tumor growth in > or = 80% of the mice and elicited an antigen-specific cytotoxic T lymphocyte response, whereas other administration routes were not as effective. Ad2/mugp100 administered to two i.d. sites did not inhibit tumor growth or provoke cellular immunity. Immunization was less effective with active treatment where tumor growth was not significantly inhibited by a single dose of either Ad2/muTRP-2 or Ad2/hugp100. However, increasing the number of intradermal immunization sites and the number of doses resulted in progressive improvements in protection from tumor growth in the active treatment model. In conclusion, breaking host tolerance to elicit protective immunity by using adenoviral vectors expressing melanoma-associated antigens is dependent upon the choice of antigen, the site of administration, and the number of doses. These observations provide insights into the clinical applicability of adenoviral vaccines for immunotherapy of malignant diseases.

[Biological monitoring of persons in areas with increased soil mercury, arsenic and antimony content]. / Biomonitoring-Untersuchung bei Personen in Wohngebieten mit erhöhten Bodenwerten an Quecksilber, Arsen und Antimon.

Part of the northern Palatinate region in Germany is characterised by elevated levels of mercury, arsenic and antimony in the soil due to the presence of ore sources and former mercury mining activities. In a biomonitoring study, roughly 200 residents of this region were investigated for a putative increased absorption of these elements. Urine and scalp hair samples were examined. The results did not show a correlation between the mercury and antimony contents in the soil of the housing area and those in urine and hair. On the other hand, slightly but presumably non-hazardous, elevated arsenic contents in urine and scalp hair could be correlated to an increased arsenic content in the soil. According to multiple regression analysis this increase also correlated with the consumption of poultry, eggs and vegetables kept and cultivated respectively in grounds contaminated with arsenic. In urine, sex differences could be seen for antimony: male probands showing significantly higher mean urinary antimony levels than female probands. Urinary mercury contents were correlated with the amalgam area. Similarly, scalp hair of men contained significantly higher levels of arsenic and antimony in comparison to women. Mercury contents in scalp hair were correlated with the consumption of seafood. Children aged 2 to 6 years had significantly lower levels of mercury, arsenic and antimony in urine than the adult subjects. Thus, an elevated health hazard to these children by e.g. intake of contaminated soil is not expected.

Human biomonitoring of antimony.

OBJECTIVES: The aim of the study was to test the suitability of 24-h urine, blood, and scalp-hair samples as surrogates for the determination of internal exposure to antimony in case of a strongly elevated soil contamination with antimony. METHODS: The bio-monitoring was performed using graphite-furnace atomic absorption spectrometry. Blood and scalp-hair samples were decomposed by microwave digestion. RESULTS: No elevated content of antimony could be detected in 24-h urine, blood, or scalp-hair samples from the study participants geogenically exposed to antimony. The results did not show a correlation between the antimony contents in the soil of the housing area and those in urine, blood, or hair. Surprisingly, the reference group (n = 47) showed a significantly higher median antimony excretion rate than did the exposed group (n = 89; 1.23 versus 0.60 micrograms Sb/24 h). Additionally, the scalp-hair contents of the reference group were also significantly higher than those of the exposed persons (0.045 versus 0.026 mg Sb/kg). Blood contents of the two study groups were 0.57 and 0.48 microgram Sb/l, respectively. The detection limit for urine and blood was 0.5 microgram Sb/l and that for scalp hair was 0.005 mg Sb/kg. Of all samples of urine, blood, and scalp hair analyzed, 31.2%, 49.3%, and 10.3%, respectively, were below the limit of analytical detection. CONCLUSIONS: The antimony contents recorded for both study groups in urine, blood, and scalp hair can be judged as being within the normal range. The rate of transfer of antimony from the soil to humans in the exposure case described seemed to be very low. With respect to analytical practicability and validity, urine was the surrogate which deemed most useful for determination of internal exposure to antimony.